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California’s Nursing Workforce: New Research A presentation given by Joanne Spetz to the California Healthcare Workforce Policy Commision
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California’s Nursing Workforce: New Research
Joanne Spetz, Ph.D. University of California, San Francisco February 7, 2012
What is going on in our RN labor market? • More than a decade of severe shortage,
1998-2008 • Reports that new graduates cannot find
jobs 2009-now • Stories that nurses are not retiring when
expected • Shortages in some regions
Context: Ongoing recession, high unemployment, severe regional differences
2
Survey of Nurse Employers, Fall 2010 • Collaboration between UCSF, CINHC, and HASC • Email survey with option to return paper survey
via fax or email • Questions based on previous CINHC survey and
National Forum of State Nursing Centers “Minimum Demand Data Set” recommendations
• Follow-up short survey conducted Spring 2011
3
Perceptions of employers, fall 2010
4
Differences across regions, Fall 2010 & Spring 2011
5 Lower number = more shortage
Rural versus urban perceptions
6 Lower number = more shortage
Staff RN Vacancies, Fall 2010 & Spring 2011
7
Estimated 1,772 vacancies for new RN graduates in Fall 2010
Planned employment growth for 2011 & 2012, from Fall 2010
8 These data are for respondents, not all California hospitals
BRN surveys
• Survey of RNs, 2010 – 10,000 RNs sampled, ~65% response rate – Paper survey with option to do online survey
• Annual Schools Survey, 2010-11 – Online survey of all nursing programs – 100% response rate
9
Employment rates by age, 2008 & 2010
10
Source: California Board of Registered Nursing Survey of RNs, 2010
Reasons for not working in nursing % important or very important
0% 20% 40% 60%
Retired
Childcare responsibilities
Stress on the job
Job-related illness/injury
Salary
Dissatisfied with benefits
Other dissatisfaction with your job
Dissatisfaction with the nursing…
Wanted to try another occupation
Inconvenient schedules in nursing jobs
Difficult to find a nursing position
Laid off
20102008
11
Source: California Board of Registered Nursing Survey of RNs, 2010
Nurse earnings over time
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Source: California Board of Registered Nursing Survey of RNs, 2010
Future plans of RNs
0%10%20%30%40%50%60%70%80%90%
100%
Under35,
2008
Under35,
2010
65+,2008
65+,2010
Plan to retire
Plan to leavenursing entirely, butnot retirePlan to increasehours of nursingworkPlan to reducehours of nursingworkPlan to workapproximately asmuch as now
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Source: California Board of Registered Nursing Survey of RNs, 2010
RN Graduations are expected to drop in 2012-2013
New enrollment
Projected enrollment from 1 yr
Projected enrollment from 2 yrs
Graduations
2008-2009 13,988 14,621 13,692 10,526 2009-2010 14,228 14,917 14,216 11,512 2010-2011 13,055 14,835 12,447* 2011-2012 13,223 13,273* 2012-2013 11,616* 2013-2014 11,766*
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Source: California Board of Registered Nursing Annual Schools Report, 2009-2010
Board of Registered Nursing Forecasts of Supply
15
Nurses with Active Licenses
Living in California Outflow of nurses Inflow of nurses
Full-time equivalent supply of RNs
Share of nurses who work, and how much they work
The range of supply forecasts (RNs living in California)
16
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
Best Supply ForecastLow Supply ForecastHigh Supply Forecast2009 Forecast
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
Variation in FTE employment with assumptions about work and retirement
17
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
Best Supply ForecastLow Employment Rate ForecastHigh Employment Rate Forecast2009 Forecast
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
Forecast of Full-time Equivalent RNs per 100,000 population
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0
100
200
300
400
500
600
700
800
900
1,000
Best Supply Forecast
U.S. average
US 25th percentile
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
What is demand?
• National benchmarks: Employed RNs per 100,000 • Bureau of Labor Statistics, forecast of 2018
demand • Growth based on current hospital employment &
expected growth in patient days • Potential impact of PPACA
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Forecasts of RN demand
20
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
National 25th percentile FTE RNs/population
National average FTE RNs/population
California Employment Development Dept. forecast
Maintain 2011 FTE RNs/Population
OSHPD hours per patient day-based forecast, BRN calibration
OSHPD hours per patient day-based forecast, EDD calibration
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
Best supply and demand forecasts for RNs, 2009-2030
21
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
Best Supply ForecastNational 25th percentile FTE RNs/populationOSHPD hours per patient day-based forecast, BRN calibrationLow Supply Forecast (low count & employment)National average FTE RNs/population
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
Implications for policy
• How do we define shortage? – Are current employment levels adequate? – Should California be at the national average? 25th
percentile? Bottom? – Economic demand vs. need-based demand
• In this economy… – Demand estimates have dropped and supply is high
22
What is happening next?
• UCSF, CINHC, and the Hospital Associations is analyzing Year 2 of the employer survey
• UCSF & BRN are nearly done with the 2011-12 Annual Schools Survey
• 2012 BRN Survey of RNs (mailed in spring)
23
Questions?
Thoughts? Ideas? Perspectives?
24